MEDICARE: CHARLESTON ORTHOPEDIC APPLIANCES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier	NOT APPLICABLE	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000201174	OTHER	WV	BLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number	:	1649203670
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLESTON ORTHOPEDIC APPLIANCES INC

Provider Business Mailing Address
First Line	:	1532 KANAWHA BLVD W
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25312-2533
Country	:	US
Telephone Number	:	304-343-8994
Fax Number	:	304-720-2078

Provider Business Practice Location Address
First Line	:	1532 KANAWHA BLVD W
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25312-2533
Country	:	US
Telephone Number	:	304-343-8994
Fax Number	:	304-720-2078

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CECIL A TANKERSLEY
Credential	:	CO,BOCO,C-PED,RTO
Telephone Number	:	304-343-8994

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/29/2009

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Directions to “CHARLESTON ORTHOPEDIC APPLIANCES INC ” Practice Location

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